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Abstract: FR-PO093

Sepsis and Septic AKI Sequence: The Most Important Complication of Steroid Responsive Nephrotic Syndrome

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Ghosh, Saptarshi, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
  • Sinha, Debanjan Dr, Dr B C Roy Post Graduate Institute of Pediatric Sciences, Kolkata, IN, India
  • Ghosh, Sanat Kumar, Dr B C Roy Post Graduate Institute of Pediatric Sciences, Kolkata, IN, India
Background

Sepsis is a well recognized complication of nephrotic syndrome. Systemic inflammatory response syndrome (SIRS) insult in the nephrotic background initiates interplay between inflammation and oxidative stress, leading to septic acute kidney injury (SAKI). Sepsis and SAKI sequence develop as a complication of nephrotic syndrome. Data on this subject is lacking. The present study is conducted to know the prevalence, clinical profile, morbidity and outcomes of this sequence in steroid responsive nephrotic syndrome.

Methods

This observational study is conducted at Dr B C Roy PGIPS, Kolkata, India. Consecutively hospitalised children with steroid responsive nephrotic syndrome below 12 years were included after exclusion of pre-existing chronic kidney disease. Sepsis & septic shock were identified by Sepsis-3 criteria and AKI was identified by KDIGO. AKI developing in the background of sepsis was defined as SAKI. Hospital stay, requirement of ICU care, inotropes,ventilator support and renal replacement therapy (RRT) were used as indicator of morbidity.

Results

Out of 235 subjects, 64 (27.23%) developed AKI. 59 (92.18%) of them were SAKI. Among the 59 subjects with SAKI, 40 (67.79%) had sepsis and 19 (32.20%) had septic shock. As per KDIGO, AKI staging of 59 patients with SAKI– 38 (64.4%), 12(20.33%) and 9 (15.25%) subjects developed stage 1, stage 2 and stage 3 AKI respectively. Severity of AKI was associated with sepsis 3 score (p value <0.0000). Clinical features included features of peritonitis, sepsis, or septic shock followed by prolongation of the oliguric phase, development of hypertension, azotemia. Edema, azotemia subsided with diuresis. Hypertension persisted for a variable period. Duration of hospital stay, requirement of ICU care and mortality were higher in this group compared to non-AKI group (p value 0.00005360, <0.0000001 and 0.02215 respectively).
Prevalence of sepsis-AKI sequence in steroid responsive nephrotic syndrome was quite high. Sepsis-3 score correlated with severity of AKI staging. SAKI was associated with increased length of hospital stay, increased frequency of inotropes & ICU requirement and increased mortality.

Conclusion

Sepsis--AKI sequence is the most important complication of steroid responsive nephrotic syndrome. Published data on septic AKI in nephrotic syndrome is very scanty.